Please complete this application below if you are interested in becoming a Great Plains Health JV Ambassador. Once you complete the form, click the submit button at the bottom. Our director of volunteer services will contact you to schedule an interview within 48 hours of submission.


Name and address


Emergency contact


Mother's Name

Please include first and last name with contact phone number.



Father's Name

Please include first and last name with contact phone number.



Guardian's Name

Please include first and last name with contact phone number.



Education

List school(s) and degree(s) if available.



RSVP member

Please indicate YES or NO if you are a member of the North Platte Ready to Service Volunteer Program.



Availability

Please indicate the days and times you are usually available to volunteer.



Previous work experience

Please comment if you have been previously employed by Great Plains Health.



Previous volunteer experience including

Include your school and community activities along with previous volunteer experience in this section.



Reasons for volunteering


References

Please list at least two references who are not relatives. Preferrably someone who has supervised you in a volunteer or work environment.



Service and Confidentiality Statement

I wish to donate my services to Great Plains Health and understand there is no payment for services rendered under the volunteer program of Great Plains Health. I agreed to abide by the rules, regulations and policies of the hospital. I further understand confiddentiality must be maintained at all times. I understand that if I do not abide by the rules, regulations and hospital policies, or break confidentiality, I will be terminated from the volunteer program.